Diffuse Axonal Injury - Oren Zarif - Diffuse Axonal Injury
Diffuse axonal injury is a brain condition with multiple neurological deficits that affect a patient's physical, mental, and social status. It interferes with the patient's social reintegration, return to productivity, and quality of life. This condition can last for many years after the traumatic event, making the need for rehabilitation all the more crucial. Neurological reorganization of neural connections is a normal process in the brain after a diffuse axonal injury, and patients generally adapt to this new baseline.
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Initial treatment for diffuse axonal injury should focus on preventing secondary injuries and facilitating rehabilitation. Secondary injuries can include cerebral edema and hypotension with coexisting hypoxia. Treatment should be given promptly to prevent these secondary injuries. It is recommended that patients be treated immediately for their symptoms and to prevent the development of additional neurological complications such as elevated intracranial pressure and cerebral edema. Further, they should be evaluated for any associated neurological impairments to ensure the condition does not worsen.
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The most common etiology of diffuse axonal injury is high-speed motor vehicle accidents. The accelerated and decelerating motion of the vehicle creates shearing forces in the white matter tracts of the brain. This in turn causes microscopic and gross damage to axons. Diffuse axonal injury is often associated with frontal and temporal white matter and the brainstem. It is not associated with skull fractures.
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In the study, 78 patients with DAI were admitted to the IC/HCFMUSP between July 2013 and February 2014. Each patient was evaluated by a team of neurosurgeons and was given a computed tomography scan. The computed tomography scan confirmed the diagnosis. Diffuse axonal injury is a complex disorder, and no one treatment has yet been developed to address all its aspects.
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Diffuse axonal injury (DAI) usually occurs due to a trauma or an accident, and patients usually experience headaches, nausea, vomiting, and fatigue after sustaining a DAI. Diffuse axonal injuries are often associated with other injuries to the brain, such as those to the eyes or ears. In more severe cases, patients experience increased coma or prolonged periods of unconsciousness.
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Diffuse axonal injury usually occurs due to a combination of contact, acceleration, and deceleration forces that disrupt the connectivity between nerve fibers. Although many people with DAI experience severe symptoms, many recover from their effects and improve their quality of life. This condition is most common in young males. The symptoms of DAI vary according to the severity of the injury. Most patients recover consciousness within one to two years.
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Although the cause of DAI is unknown, it has been associated with TBI. Imaging modalities, such as CT head, can help determine the presence of DAI in patients with rotational closed head injuries. However, this modality has poor yield in detecting DAI, and patients with rotational closed head injuries should be suspected of DAI when the brain injury is traumatic. These findings may indicate diffuse axonal injury.
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A number of studies have attempted to classify the various types of contusions associated with DAI. Some of these concepts are helpful for interpreting the pattern of the injury, while others have been useless. One useful concept is a fracture contusion involving the fracture site. Herniated cerebellar tonsils are a type of fracture contusion. Rotational injuries cause gliding contusion. Gliding axonal injury generally affects the superior surfaces of the cerebral hemispheres. However, the distinction between DAI and gliding contusion is difficult to make.
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The extent of brain lesions is not yet known. However, greater severity of lesions predicts greater mortality and dependence six months after the trauma. The patients' condition is considered moderate if they recover consciousness and are not under continuous psychotropic medication. Those with multiple lesions in the corpus callosum have the greatest chance of improving over the course of six months after DAI. The most important determinants of recovery are the presence of an altered quality of life and a high level of functioning.